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Validation of a point‐of‐care prothrombin time test after cardiopulmonary bypass in cardiac surgery
Author(s) -
Meesters M. I.,
Kuiper G.,
Vonk A. B. A.,
Loer S. A.,
Boer C.
Publication year - 2016
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/anae.13591
Subject(s) - medicine , cardiopulmonary bypass , protamine , prothrombin time , point of care , point of care testing , cardiac surgery , anesthesia , limits of agreement , prothrombin complex concentrate , cardiology , warfarin , nuclear medicine , heparin , pathology , atrial fibrillation
Summary Point‐of‐care coagulation monitoring can be used for the guidance of haemostasis management. However, the influence of time on point‐of‐care prothrombin time testing following protamine administration after cardiopulmonary bypass has not been investigated. Bland–Altman and error grid analysis were used to analyse the level of agreement between prothrombin time measurements from point‐of‐care and laboratory tests before cardiopulmonary bypass, and then 3 min, 6 min and 10 min after protamine administration. Prothrombin times were expressed as International Normalised Ratios. While the point‐of‐care and laboratory prothrombin time measurements showed a high level of agreement before bypass, this agreement deteriorated following protamine administration to a mean (SD) bias of −0.22 (0.13) [limits of agreement 0.48–0.04]. Error grid analysis revealed that 35 (70%) of the paired values showed a clinically relevant discrepancy in international normalised ratio. At 3 min, 6 min and 10 min after cardiopulmonary bypass there is a clinical unacceptable discrepancy between the point‐of‐care and laboratory measurement of prothrombin time.